title: Effects of mono- and dual blockade of the renin-angiotensin system on markers of cardiovascular status in hypertensive patients with mild and moderate renal failure.
abstract: OBJECTIVE
  Dual renin-angiotensin system (RAS) blockade has no more efficiency to decrease cardiovascular mortality than mono-blockade. Our goal was to explore differences between other cardiovascular markers in patients with RAS blockade.
  
  
  METHODS
  We analyzed two groups of patients treated with a long-term ACE inhibitor (MONO-group, n = 20) and an ACE inhibitor and angiotensin II receptor blocker (DUAL-group, n = 15). Ambulatory blood pressure monitoring, echocardiography, arterial stiffness and levels of catecholamine, endogenous ouabain (EO), pro-brain natriuretic peptide and more types of urinary albumin measurements were performed.
  
  
  RESULTS
  In the DUAL-group, we found significantly better cardiac parameters, but the levels of EO and urinary albumins were similar in both groups. The level of EO correlates with nighttime mean arterial blood pressure (R = 0.556, p = 0.032) and arterial β-stiffness (R = 0.512, p = 0.042). Urinary immuno-unreactive albumin showed a relationship with diastolic dysfunction of the heart (R = -0.508, p = 0.045) diurnal index of diastolic blood pressure (R = -0.569, p = 0.021) in the MONO-group.
  
  
  CONCLUSIONS
  Cardiac parameters were more prosperous in the DUAL-group, but the levels of EO did not differ between groups. The level of EO correlated with blood pressure and arterial stiffness markers in the MONO-group only. The urinary immuno-unreactive albumin may be a new marker of cardiovascular conditions.
authors.affiliation: 2nd Department of Medicine and Nephrological Center, Faculty of Medicine, University of Pécs,1 Pacsirta St., Pécs, Hungary.
authors.forename: Gábor
authors.initials: G
authors.lastname: Nagy
authors.forename: István A
authors.initials: IA
authors.lastname: Szijártó
authors.forename: Balázs
authors.initials: B
authors.lastname: Gaszner
authors.forename: Eva
authors.initials: E
authors.lastname: Lányi
authors.forename: Lajos
authors.initials: L
authors.lastname: Markó
authors.forename: Akos
authors.initials: A
authors.lastname: Mérei
authors.forename: Gergo A
authors.initials: GA
authors.lastname: Molnár
authors.forename: Kinga
authors.initials: K
authors.lastname: Németh
authors.forename: József
authors.initials: J
authors.lastname: Betlehem
authors.forename: István
authors.initials: I
authors.lastname: Wittmann
mesh_terms: D000368:Aged; D000418:Albumins / Q000032:analysis; D001158:Arteries / Q000503:physiopathology; D015415:Biomarkers; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002320:Cardiovascular Physiological Phenomena; D002395:Catecholamines / Q000652:urine; D003430:Cross-Sectional Studies; D003928:Diabetic Nephropathies / Q000150:complications / Q000473:pathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009400:Nephrosclerosis / Q000150:complications / Q000473:pathology; D010042:Ouabain / Q000097:blood / Q000652:urine; D010446:Peptide Fragments / Q000097:blood; D051437:Renal Insufficiency / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012189:Retrospective Studies
chemical_list: D000418:Albumins; D015415:Biomarkers; D002395:Catecholamines; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D010042:Ouabain